Provider Demographics
NPI:1417547217
Name:EDWARDS, DORIFLORE (FNP)
Entity Type:Individual
Prefix:
First Name:DORIFLORE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9891 GOOD LUCK RD APT 4
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3239
Mailing Address - Country:US
Mailing Address - Phone:240-486-7934
Mailing Address - Fax:
Practice Address - Street 1:10801 LOCKWOOD DR STE 160
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1586
Practice Address - Country:US
Practice Address - Phone:301-298-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNONEMedicaid